Risk-Adjusted Utilization Index



Risk ‐ Adjusted   Utilization   Index  


Utilization   (amount   of   functional   status   change   per   visit)   can   be   risk ‐ adjusted   by   taking   advantage   of   a   risk ‐ adjusted   3x3  


value ‐ based   purchasing   table

 ‐  an   average   "weighted   /   distribution"   of   the   Functional   Status   Change   to   Visits.


In   the   table,   risk ‐ adjusted   residuals   of   functional   status   change   are   divided   by   percentiles   into   low   (i.e.,   lowest   third   or   worst   outcomes),   expected   (i.e.,   middle   third)   and   high   (i.e.,   highest   third   or   best   outcomes),   and   risk ‐ adjusted   residuals   of   number   of   treatment   visits   are   divided   by   percentiles   into   fewest   (i.e.,   lowest   third   or   fewest   number   of   visits),  

  expected   (i.e.,   middle   third)   and   more   (i.e.,   highest   third   or   most   number   of   visits).


With   Functional   Status   (FS)   change   in   3   rows   (highest   on   top)   and   visits   in   3   columns   (fewest   on   left),   a   3   X   3   table   is   created   where   those   with   better   than   predicted   FS   change   treated   in   fewer   than   predicted   visits   are   in   cell   1   in   the   upper   left   corner,   and   those   with   worse   than   predicted   FS   change   treated   in   more   than   predicted   visits   in   cell   9   in   the   lower   right   corner.

  Clinically,   you   would   not   want   to   be   a   patient   in   cell   9   (lower   right   corner)   where   your   outcomes   were   worse   than   predicted   with   a   higher   number   of   visits,   but   you   would   prefer   to   be   in   cell   1   (upper   left   corner)   where   your   outcomes   were   better   than   predicted   and   delivered   in   the   fewest  

  number   of   visits.


Once   each   patient   is   placed   in   one   of   the   9   cells   in   our   3   X   3   table,   a   score   is   created   for   the   unit   being   analyzed,   such   as   the   clinic   or   clinician,   that   represents   a   risk ‐ adjusted   utilization   index   from   which   the   risk ‐ adjusted   percentile   ranking   is   calculated.





For   Example:


Clinic   A’s   patients   were   scored   using   the   3x3   value   table.


Then,   the   percentage   of   patients   for   the   Unit   that   fell   into   the  

High   cells   (1,2   and   4),   Expected   cells   (3,5   and   7)   or   Low   cells  

(6,   8   and   9)   is   calculated.



The   percentage   of   patients   in   each   grouping   is   then   multiplied   by   the   weight   for   each   grouping,   to   establish   the   weighted   sum   of   the   total   of   all   3   weighted   scores.

  Please   note   that   the   weighted   sum   ranges   are   from   0.17

  to   0.50

  and   all   scores   will   be   rounded   on   the   quarterly   profile  

  report   to   two   decimal   points.


It   is   the   weighted   sum   that   is   compared   with   all   other   user   weight   sums   to   determine   the   national   utilization   percentage   ranking   for   each   unit,   using   the   0.17

  to   0.50


    A   minimum   of   forty   (40)   complete   discharged   episodes   for   the   rolling   12   months   (or   10   per   quarter)   is   required   to   receive   a   percentile   ranking.

   An   estimated   percentile   rank   is   provided   if   the   complete   discharged   episodes   do   not   meet   the   minimum   criteria,   noted   by   an   asterisk   (*)   in   the  

  percentile   rank   cell.



This   information   is   included   on   the  

Quarterly   Profile   Reports   and   on   the   Scorecard

  in   the   Report   Portal.






On   the   Profile   Reports,  

Utilization   is   surfaced   on   each   body   part   impairment   page,  



showing   the   percentage   of   patients   in   each   of   the   3   categories,   the   weighted   sum,    and   the   national   percentile   ranking   this   weighted   sum   represents   in  


the   National   database   for   the   rolling   12   month   period.






On   the   Scorecard

,   to   provide   you   with   an   At ‐ A ‐ Glance   reference   to   the   Utilization   Index,   the   HIGH   Utilization  

Column   is   Highlighted   to   designate   if   the   percentage   of   your   patients   falling   into   the   HIGH   Category   is   lower   than   the   percentage   of   patients   falling   into   the   LOW   Category.

   The   goal   is   to   have   the   majority   of   your   patients   falling   into   the  

HIGH   and   EXPECTED   utilization   category.